Billing, Claims Resolution Specialist

Overview

Billing, Claims Resolution Specialist (66921) – Variety Care. Department:
Billing. Position:
Claims Resolution Specialist. Employee Category:
Non-Exempt. Reporting Relationship:
Manager of Revenue Cycle Management.

• Collaborate with the Senior Claims Resolution Specialist and the Manager of Revenue Cycle Management to determine focus areas for collections after reviewing the weekly AR report.
• Contact third-party payers about outstanding balances and provide requested documentation to achieve resolution.
• Contact patients with outstanding balances to obtain payment or set up payment plans; send statements and collection letters on past due balances.
• Track and follow up on payment plans to ensure compliance; perform write-offs, adjustments, and refunds as directed.
• Work closely with the Billing team to respond to billing inquiries and resolve outstanding balances; answer patient calls and billing questions.
• Process medical records requests for payers from attorneys; assist front desk staff with patient inquiries and obtaining correct patient addresses.
• Meet established daily, weekly, monthly, and annual deadlines; manage relationships with payors to improve patient revenue.
• Uphold Medicare, Medicaid, and HIPAA compliance guidelines related to billing, collections, and PHI information.
• Follow written and verbal instructions from the Manager of Revenue Cycle Management and Sr. Claims Resolution Specialist; maintain professionalism in communication with patients, clients, insurance companies, and co-workers.
• Participate in special projects as assigned and support accreditation as a Patient-Centered Medical Home; contribute to the goals of healthcare reform’s Triple Aim by improving care experience, health outcomes, and cost reduction.
• Perform other duties as assigned.

• Must be able to lift and/or move up to 25 pounds.
• Regularly required to sit, stand, walk, and talk; may need to bend and reach to perform duties.

• High School Diploma or GED.
• Two years of prior billing and collections experience.
• Working knowledge of CPT codes; ability to read and understand Explanation of Benefits (EOB).
• Strong analytical, independent-thinking, problem-solving, and decision-making skills.
• Effective communication with individuals at various levels, often in sensitive situations.
• Proficiency with Microsoft Office and practice management software; bilingual (English/Spanish) is a plus.

• Associate degree or equivalent combination of experience and education.
• Prior medical billing and insurance collections or healthcare revenue cycle experience including payers, managed care contracts, and payer methodology.